Georgia is on the brink of becoming the sole state in the nation to implement work requirements for Medicaid recipients. This innovative approach, set to commence this weekend, aims to extend healthcare coverage to thousands of additional residents. However, eligibility for coverage is contingent upon individuals proving that they work or participate in job training or other activities for 80 hours per month.
Conservatives are increasingly prioritizing Medicaid work requirements, with the expectation that a future Republican administration would approve such requests. Under the Trump administration, 13 work requirement programs were sanctioned, although two approvals were struck down by a federal judge in 2019 and another 10 were revoked by the Biden administration. Momentum around implementing work requirements stalled as a result.
Nevertheless, House Republicans have recently revived efforts to establish work requirements, and it became a sticking point in debt ceiling negotiations. Although excluded from the final compromise legislation due to opposition from President Biden and Democrats, the Congressional Budget Office estimated that such requirements would save the government $109 billion without increasing employment levels. However, it was projected that around 600,000 adults would lose their Medicaid coverage under the bill.
Experts, like Joan Alker from the Georgetown University Center for Children and Families, highlight the persisting interest in Medicaid work requirements despite evidence that they do not achieve their intended goal of supporting employment. It is anticipated that such policies would resurface if there is a change in administration.
Supporters of work requirements argue that they are necessary to incentivize individuals to lift themselves out of poverty. Chris Denson from the Georgia Public Policy Foundation believes that Georgia’s program has the potential to be beneficial as it provides a pathway for individuals to obtain commercial insurance rather than relying on Medicaid.
To navigate legal challenges, some GOP state officials are attempting alternative approaches. Arkansas, for example, submitted a new waiver to the Biden administration seeking permission to introduce work requirements for people on its expanded Medicaid program. Governor Sarah Huckabee Sanders emphasized the potential of work requirements to address workforce challenges and help individuals escape government dependency.
While Georgia’s application for its Pathways to Coverage program was approved in the final days of the Trump administration, the Biden White House rescinded the work requirements and the policy on monthly premiums. However, Governor Brian Kemp sued, and a federal judge ruled in favor of the state, allowing the program to proceed. Estimates on the number of people who will benefit from the program vary, with initial projections of 50,000 rising to approximately 345,000. Skepticism exists regarding the ability of many to meet the reporting requirements.
Georgia has one of the strictest Medicaid eligibility criteria in the country, extending coverage only to parents earning up to approximately 30% of the federal poverty line. Despite criticism that Georgia is missing out on significant federal funding by refusing to adopt full Medicaid expansion under the Affordable Care Act, the Pathways program will cost more to cover fewer people. Experts argue that Georgia’s expansion would cover over 400,000 individuals, costing state taxpayers an additional $10 million per year compared to full expansion.
Furthermore, Georgia is foregoing the temporary bonus provided by the American Rescue Plan, which aims to incentivize broadening coverage. This decision means the state is missing out on over $1.3 billion in bonus funds over two years, in addition to the federal government’s promise to cover 90% of expansion costs.
Under the Pathways program, Medicaid coverage will be partially extended to individuals with incomes below the federal poverty level. However, applicants must demonstrate that they already meet the 80-hour work requirement, with no grace period or exemptions for full-time caregivers or other relatives.
Individuals covered under standard Medicaid will not be subject to work requirements.
The Georgia Public Policy Foundation believes that the unique aspect of Georgia’s partial expansion sets it up for success and hopes that the program will serve as a model for other states.
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